Being a doctor – or any public sector worker – shouldn’t be such a battle. That’s why we must support junior doctors in their planned strikes.
For the last 9 years I have been the medical director of an NHS service providing confidential help to doctors and dentists with mental health problems, seeing a rising number of doctors week on week.
But our patients have changed.
In our early days the ‘typical’ patient was an older male (GP or psychiatrist) with alcohol problems.
Now nearly half of all new patients are under 30 years old. They come to us with depression, anxiety and symptoms akin to posttraumatic stress disorder. Many have worked in the NHS only a few years. They started out bushy tailed and bright eyed, but end up ‘burnt-out’ (a polite euphemism for depression) after only a few years working. Our youngest patients are only a few months qualified and many are in their Foundation years.
Patient after patient talks of feeling betrayed and bewildered by their loss of enthusiasm about a profession that they had strived to enter (often since their early teens). How their desire to care for patients is sapped by every working day. The language they use to describe their work is that of the battlefield. Being on the ‘front-line’, of ‘surviving’ another shift, being ‘at war’ with management. They talk of feeling abandoned by the NHS. Of working intolerable shifts that appear to have been designed by robots with no concept that humans will need to work them. Of having no sustenance – literally and metaphorically – as they try their best to deliver care to patients.
They talk of working in an unforgiving environment – where every error will lead to punishment and where every move is watched and recorded. They describe the fun having gone out of their profession. They say that they cannot see a future any more in medicine.
Hardly surprising therefore that the numbers progressing through training (from the early Foundation Years to the start of specialty training) is reducing. That now nearly half of doctors are not progressing. And that this is against a background of fewer of our brightest entering medicine in the first place.
Our junior doctors are striking for more than pay and conditions – important though these are. Their planned strike is consciously or unconsciously action to shine a light on what is going on within the NHS – to shine a light on the conflict between idealism and industrialization.
Increasing privatisation has changed the relationship doctors have with their patients. Constant reorganisation has fragmented services, and shattered long-standing teams. At a series of NHS listening events I held in 2014, the overwhelming term used by all NHS staff to describe their working environment was ‘Fear’.
The pay of junior doctors has never been good – not when calculated across the hours worked, the responsibilities they have and when compared to their non-medical peers.
But this was part of the compact we all had – we gave our all for our patients and the organisation we worked in gave their all to us – cared for us, nurtured us, trained us. We also knew that the intolerable hours would end as we climbed the medical career ladder. Now all of this has been fractured.
The new junior doctor contract will erode not just pay but also the current safety net against exploitative hours of work. Saturdays will be counted the same as week-days (tell their children that when they are off school and wanting to see Mum or Dad). Women and others who take career breaks will be discriminated against. Junior doctors have been forced to look into the abyss and chose between pain today (strike action) or pain tomorrow (agreeing to an unfair and unsafe contract). They are being treated as children rather than the committed adults they are – their please ignored, instead accused by Jeremy Hunt of being ‘extreme’, ‘militants’, and even unpatriotic.
The junior doctors are not alone in their discontent. The nurses who are marching this Saturday, the teachers and social workers, in fact most public sector workers have seen insecurity, exploitation, fear, and subtle discrimination as the backdrop to their working lives.
The junior doctors are fighting for fairness for all of these workers. They are leading the charge for a restoration of the values that should drive our public services. For a change by those who employ them – ultimately our Government – who have a moral duty to protect those who care for some of the most vulnerable in society.
Without this change, goodwill will disappear forever and with it the glue that binds our public services together. The government must now stop their bullying tactics and accept that something is profoundly wrong the NHS today and act before it is too late.
This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence.
The junior doctor contract governs the pay and conditions of work from doctors’ foundation year to registrar level. All doctors who are not consultants or fully qualified GPs are considered ‘junior’ doctors. This contract was scheduled for renegotiation, but the British Medical Association (BMA) – the largest representative body of doctors – walked away because the offer on the table was not fair to doctors and not safe for patients.
The government’s initial response was brazen, and threatened to impose the new terms without consultation – a position it has had to water down since the BMA decided to ballot its members for strike action. Here’s why the BMA has done so the first time in 40 years:
An NHS in crisis: overworked and undervalued.
Britain’s doctors have had enough. In a stretched and underfunded health system which doesn’t train enough doctors and nurses to meet its own needs – or invest in the infrastructure needed for new hospitals and facilities unless aprivate contractor is taking a nice slice of the pie – the solution seems to have been ‘work harder and take up the slack’. According to the Royal College of Physicians, the NHS “remains reliant on doctors working longer than their contracted hours…the amount of ‘goodwill work’ is increasing year-on-year.”
Trusts struggling to pay their tithes to the private owners of NHS hospital buildings have responded by reducing staff salaries, meaning fewer doctors and nurses are covering more patients and expected to do so for free. The situation has reached crisis point and doctors are experiencing enormous burnout, with more doctors applying to live abroad every year. Into this context came the new contract.
It’s not about the money.
The ‘offer’ of the new contract has been condemned first and foremost as fundamentally unsafe. Just as with the recent tube strike, the new contract threatens to force doctors to work longer and later with fewer safeguards.
The BMA approached negotiations acknowledging financial limitations but determined to improve safety: it wanted no doctor to work more than 72 hours in a week; no more than four nights in a week on-call; a rest day either side of nights before starting back on day shifts; and facilities to sleep-in for those who otherwise make a dangerous long drive home.
The government was unwilling to accept these terms, and furthermore wanted to reduce breaks to just one 30 minute break in a ten hour on-call shift. As a recent viral video asked, could you save a life if you’d been up all night?
But it is, also, about the money.
The new contract would mean a 15-40% pay-cut depending on your specialism, with GPs and emergency care doctors being some of the hardest hit. Let that sink in.
With wages starting beneath the national median anddecreasing yearly like all public sector pay, and out of pocket expenditure for licensing, exams and indemnities, junior doctors earn significantly less than the tabloids would have you believe. Their reports often use a cunning sleight of hand: taking the figures for the pay of those doctors doing the most private work – GPs who run a private practice and some consultants who run private clinics – and presenting the data as proof of ‘greedy’ public sector workers.
There are two ways doctors’ starting wages increase: extra pay for unsociable hours, and pay advancement as you progress through the ranks of seniority and responsibility. Both of these are under threat in the new contract.
The government has suggested that working from 7am until 10pm Monday to Saturday are sociable hours – and therefore should not be paid extra – which is funny considering MPs just reduced their own working hours and increased their own pay. As for pay progression with seniority, no actual offer was made.
The changes hit women hardest.
The contract changes penalise those who take time out to start a family and those who work part-time –overwhelmingly affecting women in both cases. Additionally there are concerns that changes to breaks will make work more dangerous for pregnant women. As noted above GPs will be amongst those taking the largest wage cut, one of the few specialisms with more women than men.
Hunt and the government have shown a complete disdain for even the barest semblance of actual negotiation. When the BMA walked away from negotiations a year ago, it wasn’t as a strategy to get better terms, it was because the negotiations were a farce. It has taken the threat of industrial action for a pathetic attempt at reconciliation to come from the Department of Health, full of vague, unconvincing rhetoric. It is too little, too late. No fruitful discussions can continue with Hunt as health secretary. We have no reason to believe in his word or his competence.
We deserve more. Doctors do not take strike action lightly. Whilst we will always maintain emergency and essential services, the BMA will be balloting its members to strike against the contract in the next month. We hope to see you on the picket lines.
About the author: Nick is a junior doctor. He tweets at @ZastaNick.This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence.
A selection of recent UK and international news articles
Home Secretary waited until terror suspect was abroad before stripping citizenship | The Bureau of Investigative Journalism … [Home Secretary Theresa May] denied that it has a policy of waiting until individuals are out of the UK before removing their citizenship. But research by the Bureau has also found that of the 18 individuals we have identified who have lost their UK nationality removed since 2006, at least 15 were known to be abroad when orders to remove their citizenship were issued. Of those individuals, two – Mohammed Sakr and Bilal al-Berjawi – were killed in US drone strikes in Somalia. Another, Mahdi Hashi, was rendered to the United States where he’s currently awaiting trial on terror charges in a high-security jail. Speaking in the parliamentary debate, Diane Abbott pointed out that debate around citizenship-stripping often failed to presume the innocence of individuals who had not faced criminal charges. ‘We are talking about terror suspects. Nowadays in Parliament, saying that someone is suspected of terrorist activity is enough for the political class to assume that that person does not deserve due process,’ she said. …
If the government gets its way, from May this year your family’s patient-identifiable data will be uploaded from your GP surgery to a single, centralised database for the very first time. This ‘care-data’ database will include your NHS number, date of birth, postcode, ethnicity and gender. Your medical diagnoses, including cancer and mental health, your referrals to specialists, your prescriptions, your body mass index, details of your vaccinations and screening tests and your smoking and alcohol habits will be on there too.
The scheme, led by health secretary Jeremy Hunt, is being hailed as a revolution in the use of information to improve our healthcare and to advance medical research – admirable aims indeed. But once it goes live, organisations including drug and insurance firms will be able to apply to purchase ‘pseudonymised’ details about patients. And ‘backdoors’ to the database will allow bodies like the police to enjoy direct access to your medical records as well.
These floods are washing away the founding logic of David Cameron’s government | Jonathan Freedland | Comment is free | The Guardian… But that is the least of the damage that Cameron’s words have inflicted on himself. For this government was built, the coalition formed, on a single, simple premise: that austerity was unavoidable, that there was no alternative. There could be no more spending, an assertion endorsed by the outgoing Labour government in what must rank as one of the most ill-judged jokes of modern times: “There’s no money left,” said Liam Byrne in a note left for his successor at the Treasury. But now, less than four years on, it turns out that this is no longer true. The PM has told us that, should the need be urgent enough, there is money after all. Limitless supplies of it in fact; enough to defeat nature’s wrath. To quote Cameron in full, “Money is no object in this relief effort. Whatever money is needed for it will be spent.” This rather undermines the austerity message, for it shows what was always true – that the national belt is not tightened universally and for ever but can be loosened when the government wants to loosen it. The last demonstration of that truth came nearly two years ago, when George Osborne cut the top rate of tax from 50p to 45p. That destroyed at a stroke the claim that we were all in it together, but it also illuminated a more obvious fact: that, despite all the “no alternative” talk, the government had not lost its power of discretion. Even in the age of austerity, it still got to decide what to spend money on and what not to spend it on. …
Your bills help British Gas to £600m profit – Business News – Business – The Independent Centrica is set to announce on Thursday that its British Gas household supply arm made a profit of nearly £600m last year, helped by a 10.4 per cent hike in gas prices in November and an 8.4 per cent rise in electricity prices. Politicians and campaigners said the bumper profits provided further evidence that showed the Big Six were overcharging customers in an uncompetitive market.
17/2/14 edit: That would be Alex Salmon “accused of overheating production of Scottish farmed salmond to meet Japan’s insatiable demand for sushi in return for China’s loan of two pandas to Edinburgh Zoo.”
Bottom trawling: how to empty the seas in just 150 years | Environment | The Observer“For every hour spent fishing today, in boats bristling with the latest fish-finding electronics, fishers land a mere 6% of what they did 120 years ago. Put another way, fishers today have to work 17 times harder to get the same catch as people did in the 19th century.” And the reason for this startling state of affairs is straightforward: we have caught so much fish in our own waters over the past 150 years, there is little left for us today. Some species hover at the edge of extinction. Our seas, and the floor below them, have been stripped of their riches.